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HM 427.8.2020 Rabbi Reuven Hammer (Completed Posthumously by Rabbi Avram Israel Reisner and Toby Schonfeld)

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HM 427.8.2020 Rabbi Reuven Hammer (Completed Posthumously by Rabbi Avram Israel Reisner and Toby Schonfeld) HM 427.8.2020 Rabbi Reuven Hammer (completed posthumously by Rabbi Avram Israel Reisner and Toby Schonfeld) Teshuvah Concerning Smoking1 Approved on August 31, 2020, by a vote of 12-1-6. Voting in favor: Rabbis Pamela Barmash, Suzanne Brody, Nate Crane, Elliot Dorff, Susan Grossman, Jan Kaufman, Amy Levin, Daniel Nevins, Micah Peltz, Avram Reisner, Robert Scheinberg, and Ariel Stofenmacher. Voting against: Rabbi David Fine. Abstaining: Rabbis Jaymee Alpert, Joshua Heller, Jeremy Kalmanofsky, Steven Kane, David Schuck, and Deborah Silver. יהושע בן פרחיה אומר: עשה לך רב וקנה לך חבר (משנה אבות א, ו) לזכר נשמת הרב ראובן אליעזר בן דוד ולאה ז"ל She’elah: In light of additional research findings on the use of nicotine and the burgeoning use of e-cigarettes, should smoking be prohibited? Teshuvah: Many years ago, a teshuvah by Rabbi Seymour Siegel, then chair of the CJLS, declared that “Jewish ethics and Jewish Law would prohibit the use of cigarettes”.2 But it went only so far, in the end, as to discourage the use of tobacco in “synagogues, schools and other Jewish gathering places”. In light of the extensive science that has accumulated in the years since then, this teshuvah seeks to revise and update that opinion and extend it by strengthening the ban on tobacco smoking of all types, and by addressing the issue of Electronic Nicotine Delivery Systems (ENDS), particularly as it relates to teens. Harms from Smoking According to the US Center for Disease Control and Prevention (CDC), tobacco remains the leading cause of preventable death in the world, responsible for more than 7 million deaths annually and reducing life expectancy by 10 years for smokers compared to non-smokers.[2] According to the US Center for Disease Control and Prevention (CDC), tobacco remains the leading cause of preventable death in the US, responsible for more than 480,000 people annually The Committee on Jewish Law and Standards of the Rabbinical Assembly provides guidance in matters of halakhah for the Conservative movement. The individual rabbi, however, is the authority for the interpretation and application of all matters of halakhah. 1 While there are similarities between tobacco smoking and marijuana smoking, a full discussion of the scientific characteristics of marijuana -- and the applicable halacha -- are beyond the scope of this paper. 2 The complete teshuvah by Seymour Siegel, appears in Proceedings of the Committee on Jewish Law and Standards, 1986-90, pp. 7-11 and again in Responsa 1980-1990 of CJLS, pp. 833-837 and is presented here as an appendix to this teshuvah. 1 and reducing life expectancy by 10 years for smokers compared to non-smokers.3 A study conducted by the Office of the Surgeon General of the United States demonstrated that second- hand smoke causes premature death even in those who do not or who have never smoked, and there is no “safe” or “risk free” level of exposure to secondhand smoke.4 While the 1964 US Surgeon General’s report on smoking had significant effect on public behavior,5 it was reinforced in 1988 when nicotine was officially declared addictive by the US Surgeon General because scientific evidence demonstrated that continued smoking was not simply a matter of preference, but in fact was connected to neurobiological changes in the smoker.6 There are molecular and anatomical bases for the effects of nicotine on appetite, mood, and depression, the latter in particular with adolescent smokers. Additionally, there is evidence that nicotine exposure during early development and adolescence also contributes to susceptibility to tobacco addiction later in life.7 While discussions about heated tobacco normally center on cigarettes, there are other forms of nicotine delivery systems that are equally problematic. Waterpipe tobacco smoking, known as “narghileh”, “shisha” or “hookah,” has been considered by many to be less dangerous than other heated tobacco products due to a variety of factors such as: water filtration, little or no nicotine, fewer chemicals, social acceptability, a perception that it is less addictive than cigarette smoking.8 Yet studies show that there are significant negative health effects associated with waterpipe tobacco smoking, including respiratory diseases, cardiovascular disease, metabolic syndrome, and mental health.9 And in fact, because of the heated water vapor, waterpipe tobacco 3 US Centers for Disease Control and Prevention, “Fast Facts: Smoking and Tobacco Use.” Accessed 15 June 2020. Available at: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/fast_facts/index.htm#:~:text=Smoking%20is%20the%20 leading%20cause,7%20million%20deaths%20per%20year.. 4 U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006. 5 Marshall TR. The 1964 Surgeon General's report and Americans' beliefs about smoking. J Hist Med Allied Sci. 2015;70(2):250-278. doi:10.1093/jhmas/jrt057 6 Picciotto, MR and YS Mineur (2014). Molecules and Circuits Involved in Nicotine Addiction: The Many Faces of Smoking. Neuropharmacology 76. doi:10.1016/j.neuropharm.2013.04.028. 7 Picciotto and Mineur. 8 Akl EA, Ward KD, Bteddini D, Khaliel R, Alexander AC, Lotfi T, et al. The allure of the waterpipe: a narrative review of factors affecting the epidemic rise in waterpipe smoking among young persons globally. Tob Control. 2015;24 Suppl 1:i13–i21. doi: 10.1136/tobaccocontrol-2014-051906; Akl EA, Jawad M, Lam WY, Co CN, Obeid R, Irani J. Motives, beliefs and attitudes towards waterpipe tobacco smoking: a systematic review. Harm Reduct J. 2013;10:12 doi: 10.1186/1477-7517-10-12. 9 Reem Waziry, Mohammed Jawad, Rami A Ballout, Mohammad Al Akel, Elie A Akl, The effects of waterpipe tobacco smoking on health outcomes: an updated systematic review and meta-analysis, International Journal of Epidemiology, Volume 46, Issue 1, February 2017, Pages 32–43, https://doi.org/10.1093/ije/dyw021; WHO Study Group on Tobacco Product Regulation (TobReg), Advisory note: Waterpipe tobacco smoking: health effects, research needs and recommended actions for regulators (2nd edition). Accessed 15 June 2020. Available at: https://escholarship.org/uc/item/9mn3k2fq. 2 smokers may in fact absorb more of the toxic chemicals involved in the mix than do cigarette smokers.10 Furthermore, cigars and pipes, while often smoked in a different pattern than cigarettes, remain deleterious to health. Cigars, a form of tobacco that is wrapped and heated, contain the same toxic and carcinogenic compounds found in cigarettes and are not a safe alternative to cigarettes.11 Studies show that regular cigar smoking is associated with an increased risk for cancers of the lung, esophagus, larynx (voice box), and oral cavity (lip, tongue, mouth, throat); gum disease and tooth loss; coronary heart disease, and other lung diseases.12 While fewer studies have examined the risks associated with those who exclusively smoke a pipe, data suggest that the practice confers similar risks to that of smoking cigars.13 Nicotine Dependence There are three phases of nicotine dependence: (1) acquiring and maintaining nicotine-taking behavior, which is reinforced by the “mild pleasurable rush, mild euphoria, increased arousal, decreased fatigue, and relaxation” effects often created by nicotine use.14 (2) Stopping the intake of nicotine results in withdrawal symptoms, on account of changes in the brain that nicotine ingestion has made. (3) Those who have ceased smoking remain vulnerable to relapse for "weeks, months, or even years after cessation,” demonstrating the power of the dependence on nicotine.15 Because of these three phases, effective cessation strategies must target all three phases and the effects experienced by smokers at each phase.16 That is, it will be insufficient to simply target behavior when, in fact, there are neurobiological causes for many of the behaviors smokers display. The medicalization of the treatment of smoking addresses some issues (recognizing and addressing the biology of addiction), yet creates others: one study demonstrated that framing tobacco dependence as a “brain disease” and downplaying the role of choice and autonomy may alienate smokers and may make them less likely to seek out health professionals for 10 US Centers for Disease Control and Prevention. Smoking and Tobacco Use: Hookahs. Accessed 15 June 2020. Available at: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/hookahs/index.htm. 11 US Centers for Disease Control and Prevention. Smoking and Tobacco Use: Cigars. Accessed 15 June 2020. Available at: https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/cigars/index.htm#health-effects. 12 Ibid. 13 S. Jane Henley, Michael J. Thun, Ann Chao, Eugenia E. Calle, Association Between Exclusive Pipe Smoking and Mortality From Cancer and Other Diseases, JNCI: Journal of the National Cancer Institute, Volume 96, Issue 11, 2 June 2004, Pages 853–861, https://doi.org/10.1093/jnci/djh144. 14 D’Souza, Manoranjan S., and Athina Markou (2011). Neuronal Mechanisms Underlying Development of Nicotine Dependence: Implications for Novel Smoking-Cessation Treatments. Addiction Science and Clinical Practice 6.1: 4- 16. Doi: 15 D’Souza and Manoranjan. 16 Aveyard, Paul and Martin Raw (2012). Improving Smoking Cessation Approaches at the Individual Level. Tobacco Control 21: 252-257. 3 treatment/assistance with quitting.17 Partnership between smokers and health professionals is the most likely strategy to address nicotine dependence, and words matter in developing allies.18 Laws and policies that prohibit smoking in public places have been demonstrated to improve health outcomes, some almost immediately after the policy has been implemented.19 As of 4 June 2019, 27 states, Washington, D.C., Puerto Rico and the U.S. Virgin Islands, plus hundreds of cities and counties, have enacted comprehensive smoke-free laws covering workplaces, restaurants, and bars, while another 3 states have enacted strong smoke-free laws covering restaurants and bars.
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